Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 19107 | MA |
NPI | 1063506004 |
---|---|
Provider Name | Dr. Geraldine C Garcia-Rogers |
First Address | Winchester, MA 01890-1961 |
Second Address | Winchester, MA 01890-1961 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/07/2007 |